The proposal to vaccinate 25 million babies in India annually may prevent 175 deaths from Hib meningitis in 5 years. The lives of 175 children are important. In resource impoverished areas, money spent on vaccinating 25 million babies could be spent on programmes for providing safe water. These programmes will save many hundreds of thousand lives. Leaving such considerations aside, the incidence of invasive Hib disease is low in India which also makes it difficult to justify introducing Hib vaccination. Additionally, the WHO has also been promoting a new form of Hib vaccine which has caused deaths in a large number of children. The WHO vaccine has also increased the price of DPT 30 fold.

In India 21 have so far died, in a limited experiment with the vaccine, and last week the Vietnam Government Drug Regulatory authority stopped the new form of vaccine – a Pentavalent vaccine – being used in Vietnam after 9 deaths.

The new vaccine was introduced because vaccine uptake for the previous vaccine has been poor. The new vaccine is a combination vaccine; a Pentavalent vaccine. This vaccine combines Hib and Hepatitis B vaccine with the widely used DPT vaccine. The vaccine is not licensed for use in the West but is promoted in Asia.

A large WHO sponsored study, meticulously done over 2 years (Minz study) found an incidence of Hib meningitis of 7/100000 children under-five. The figure for a saving of 175 deaths in 5 years is suggested by a mortality of 10%.

1. It shows that the Hib antigen was detected only in 8.75 per cent of patients with an abnormal CSF cytology and not 74% or 58% as suggested in the article.

2. There were only 7 cases of Hib meningitis in Vellore and one was vaccinated. The incidence of meningitis among those vaccinated in Vellore was not statistically different from those unvaccinated.

3. The Latex agglutination Test (LATS) used by the study to detect cause of meningitis, picks up 93% cases of Hib but only 39% Neisseria meningitides. Thus LATS cannot be used to look at the relative incidence of different causes of meningitis.

Conflict of Interests

The commentary says that one of the authors has a declared conflict of interest. Quoting Als-Nielsen and colleagues the reviewer says such conflict of interests has little impact on the results or data reported but it influenced the interpretation of the results and the conclusions drawn. “The fact that the data are not impacted by conflicts of interest provides persuasive reason to publish the figures from large trials such as this, regardless of the declared conflicts of interests. Publication allows data to be put out in the public domain. It can be interpreted by the scientific community, separately from the interpretations of the authors. Discerning readers and decision makers can use the data provided for health policy, based on sound cost–benefit calculations”